Dry Socket

Dry socket is an uncommon, but painful complication that sometimes develops after having a tooth pulled. It is also known as alveolar osteitis.

After a tooth extraction, a blood clot forms in the socket—the hole in the bone where the tooth once was—to protect the underlying bone and nerves. It is similar to the scab that forms over a cut on your skin to protect it while it heals.

In about 2% to 5% of cases, this natural first step in healing is disrupted. Either the clot does not form, or it is dislodged or dissolves too soon. That leaves the bone and nerve exposed to the air, food, and anything else that enters your mouth.

Several things can inhibit blood clots from forming properly or cause them to break down or dislodge too soon:

• A pre-existing infection, such as periodontal disease,
• Smoking, or anything else that decreases the blood supply to the mouth
• Aggressive chewing, spitting, or sucking on cigarettes or straws
• A dense jawbone (more common with age)
• Hormonal factors (women experience dry socket more frequently than men)

When impacted third molars (wisdom teeth) are removed, the surrounding tissue or jawbone may be affected, which can also increase the risk of dry socket.

If you start to experience a throbbing, steady pain a few days after having a tooth removed, that is a sign of dry socket. The pain may radiate up and down your face, and you may also experience pain when you drink cold water or breathe in cold air. Dry socket is not an infection, so you should not expect infection symptoms like fever or redness, but there may be an unpleasant taste and smell in the mouth from food and other debris that accumulates in the empty socket.

Dry socket will eventually resolve itself as the tissue heals over the exposed bone, usually within about a week to ten days. In the meantime, your dentist can help you ease the symptoms. He will gently irrigate the socket to eliminate food and other foreign materials, and then place a medicated dressing over the affected area. This will usually reduce pain very quickly. It may need to be replaced more than once before healing is complete. Your dentist may also recommend over-the-counter pain medications.

Your dentist or oral surgeon may place a suture to protect the blood clot, or use special packing at the time of your surgery. You should also carefully follow the after-care instructions your dentist gives you, and avoid drinking with a straw, vigorous spitting or rinsing, and smoking in the week after having a tooth removed.